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Adult groin hernia surgery in sub-Saharan Africa: a 20-year systematic review and meta-analysis

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Abstract

Purpose

To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa.

Methods

We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia.

Results

We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4–0.9). The pooled recurrence rate was 1.4% (95% CI 1.05–1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9–3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2–83.47)].

Conclusion

This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence.

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Acknowledgements

We would like to thank Fahrin Ramadan Andiwijaya for proofreading the article.

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Authors and Affiliations

  1. Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, BP: 234, Nationale 2, Route de Ngallele, Saint-Louis, Senegal

    A. Ndong, J. N. Tendeng, A. C. Diallo, M. L. Diao & I. Konaté

  2. Department of Surgery, Assane Seck University, Ziguinchor, Senegal

    O Sow

  3. Department of Surgery, Sylvanus Olympio Teaching Hospital, Lomé, Togo

    S. D. Mawuli

  4. Department of Surgery, National General Hospital of N’Djamena, N’Djamena, Tchad

    M. Kalli & O. Choua

  5. Department of Surgery, Zinder University, Zinder, Niger

    A. Harissou

  6. Department of Surgery, Bangui University, Bangui, Centrafrique

    A. D. Doumga

  7. Department of General Surgery, Gabriel Touré University Hospital, Bamako, Mali

    A. P. Togo

  8. Department of Surgery, Cheikh Anta Diop University, Dakar, Senegal

    M. Seck, I. Ka, A. O. Touré, B. Diop, P. S. Diop & M. Cissé

  9. Department of Surgery, Iba Der Thiam University, Thies, Senegal

    P. A. Ba

  10. Department of Surgery, University of Niamey, Niamey, Niger

    R. Sani

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Contributions

Idea for the article: A.N., J.N.T., A.C.D., M.L.D., R.S., and I.K. Literature search: A.N., A.C.D., O.S., S.D.M., and M.K. Data analysis: A.N. and A.C.D. Drafted the work: A.N., J.N.T., A.C.D., and M.L.D. Critically revised the work: A.H., O.C., A.D.D., P.A.T., M.S., I.K., A.O.T., B.D., P.A.B., P.S.D., M.C., R.C., and I.K.

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Ndong, A., Tendeng, J.N., Diallo, A.C. et al. Adult groin hernia surgery in sub-Saharan Africa: a 20-year systematic review and meta-analysis. Hernia 27, 157–172 (2023). https://doi.org/10.1007/s10029-022-02669-9

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